2006 Annual Report: The Czech Republic Drug Situation
Summary of the report
The year 2006 was the second year of the implementation of the National Drug Policy Strategyfor the Period 2005 to 2009 and the last year of the implementation of the subsequent Action Plan for the Implementation of the National Drug Policy Strategy for the period 2005 to 2006. According to the report which has been approved by the government, 32 (22%) of the 144 tasks of the Action Plan have not been fulfilled. The government adopted the Action Plan for the Period 2007–2009 which contains 172 specific tasks.
In July 2007, the Council of the Government for Drug Policy Coordination(the government’s advisory body for the field of drug policywith an initiating and coordinating function) was enlarged by the addition of a minister for the field of human rights and national minorities, who became the vice-chairman of the Council of the Government for Drug Policy Coordination on the basis of this provision, and also by a representatives of the Association of the Regions of the Czech Republic, the Czech Medical Association of J. E. Purkyně – Association for Addictive Diseases, and non-governmental organisations dealing with the preventionand treatmentof drug addictions; the Minister of Industry and Trade ceased to be a member of the Council. A new Committee of Representatives of Regions of the Council of the Government for Drug Policy Coordination was established. The function of the executive vice-chairman of the Council of the Government for Drug Policy Coordination was defined anew – he/she is nominated by the chairman of the Council of the Government for Drug Policy Coordination, and he/she no longer needs to be a member of the government.
More significant framework changes to the drug policyin 2006 involve the adoption of Act 108/2006 Coll. on social services which inter alia defines basic types of social services for drug users and modifies the conditions for their provision. Furthermore, the system of Certifications of Professional Competency of Services of programmes supplying specific primary preventionwas launched. No new bills were discussed by the Parliamentof the CzechRepublic, and no initiatives of members of parliament concerning drug issues were submitted in 2006.
Compared to 2005, the drug policyexpendituresfrom the state budgetincreased by approximately CZK 19 million in 2006 (€ 670 thousand); however, the expenditures from the budget of the Ministry of Healthdeclined by 45% to CZK 18 million (€ 630 thousand). The year-on-year volume of financial resources expended by regions decreased by approximately CZK 5.5 million (€ 194 thousand).
No studyfocusing on drug useamong the adult population was carried out in 2006. According to surveys from 2002 and 2004, approximately 20% of the adult population have tried an illicit drug, and the results suggest that the increasing trends from the previous decade have stopped or been reversed, even as far as cannabisis concerned, and this is also true among the group of young adults aged under 35. These favourable trends are also confirmed by the results of the 2006 HBSC surveyamong 15-year-old pupils of the ninth grades of elementary schools, which show a decline in prevalences of all types of illicit drugs (with the exception of inhalants), i.e. also with cannabis and ecstasy. According to data from available studies, approximately 2.6% of the adult population of the Czech Republic consume cannabis regularly (i.e. approximately 190,000 persons use cannabis at least once a week).
The median of the estimate of the number of problem drug users, which includes users of pervitin, as well as opiates, declined slightly in 2006; however, it is still within the limits of the confidence interval of estimates from previous years. According to these estimates, there are approximately 30,000 problem drug users in the Czech Republic; 20,000 of them are pervitin users and 10,000 opiate users, and approximately 29,000 of them inject drugs. An estimation of the number of problem users of Subutex® (substitution medical drug with buprenorphineas the active substance) was carried out for the first time – 4,500 persons. Problem use of Subutex® is especially common in Capital Prague, Central Bohemia, and Ústí nad Labem regions, where it replaces the use of heroin. Approximately 80% of the estimated number of problem drug users in the CzechRepublic are concentrated in these three regions, while pervitin users dominate in the other regions.
The number of treatmentdemands, including first treatment demands, declined in 2006 compared to 2005. It concerns all main types of drugs as far as first treatment demands are concerned, while the number of pervitinand opiate users increased in all treatment demands. Additionally, the number of treated injecting drug users and users aged under 19 declined. The relative number of treatment demands was the highest in Capital Prague, Ústí nad Labem, and Karlovy Vary regions. Pervitin was the most common primary drug among those demanding treatment in all regions (for the first time also in Capital Prague, which was the only region where heroinwas reported as the most common primary drug among those demanding treatment). The outflow of opiate users from residential (inpatient) treatment was very marked; it is probably caused by the expansion of outpatient substitution treatment.
The year 2006 confirmed a relatively good stable situation in the transmission of HIV and viral hepatitisamong (injecting) drug users. The number of newly detected cases of HIV infections among injecting drug users was the same as in 2005 (6 cases); the prevalence of HIV among injecting drug users is still far below 1%, according to available studies and monitoring systems. In the most recent national studyamong clients of low-threshold programmes, which was carried out in 2002–2003, the prevalence of HCV was 35%; local surveys or monitoring of testing in low-threshold facilities averagely find an HCV prevalence of (under) 20%.
In 2006, another increase in the number of needles and syringes distributed in exchange programmes in the Czech Republic took place reaching 3.9 million pieces (3.3 million in 2005).
A high prevalence of HIV and viral hepatitisamong the groups of users which especially come from the former Soviet Union states represents a danger in terms of possible further dissemination. The number of HIV and HV tests of drug users declined in 2006 and it means a growing problem for the monitoring and control of the epidemiological situation.
A marked year-on-year decline in the number of fatal overdoses occurred in terms of all main groups of street drugs which are traditionally involved in overdoses (ten cases of fatal overdoses on opiates, twelve on pervitin, and fourteen on inhalantsin 2006). It especially involves opiates but also inhalants and pervitin, i.e. substances in which this decline has been obvious since 2003 or 2004, respectively. Sporadic overdoses on ecstasyand cocainehave been reported in the last three years. No death with the presence of methadoneor Subutex® occurred in 2006. However, the number of deaths with the presence of pervitin which occurred for reasons other than overdose(especially during accidents, including traffic ones) has been increasing in the last two years.
A wide spectrum of services with good accessibility provides for harm reduction,treatmentand resocialisation of drug users in the CzechRepublic. The network of low-thresholdprogrammes has remained stable (approximately 60% of problem drug usersare in contact with them, and, according to the most recent estimates, up to 70% in Prague). The network of inpatienthealth facilities and therapeutic communities did not change markedly in 2006.
The situation in the field of providing special outpatient health care continues to be unclear – the number and availability of AT clinicsand their utilization by drug users are not known accurately.
Two medicines continue to be available for the substitution treatmentof opiate addiction – methadoneprepared from an imported generic substance, which is only available in specialised substitution centres, and Subutex®(with buprenorphineas the active substance) in the form of a proprietary medical preparation, which is available in pharmacies and can be prescribed by any physician, regardless of his/her specialisation.
Another increase in the number of patients treated in specialised substitution centres took place in 2006 (there were 950 of them). Programmes are used the most extensively in Capital Prague and Ústí nad Labem regions, which corresponds to the regional distribution of problem opiate users and their concentration in these regions; the Pilsen, Liberec, Pardubice, Vysočina, and Zlín regions continue to lack coverage; the situation in Pilsen can be regarded as alarming because of the estimated 650 problem opiate users.
The quantity of Subutex® consumed is growing. Neither the number of physicians prescribing it nor the number of persons who use it in substitution treatmentis known. The reason is that the Substitution Treatment Register kept by the Institute of Health Information and Statistics of the CzechRepublic does not cover most of the outpatient facilities prescribing Subutex®. A pilot electronic application which should provide for nationwide reporting was launched in 2007. The impossibility of registering physicians and patients is one of the main reasons for the leakage of Subutex® onto the black market, where it is bought and sold in small quantities of tablets among individual users who trade in surplus tablets prescribed by several physicians. The continuing absence of nationwide registration could lead to fatal consequences in terms of the planned introduction of methadonein the form of a proprietary medical preparation which will be available in pharmacies as of 2008, because there is a far higher risk of overdoseon methadone if it gets to the black market than there is with Subutex®.
The number of drug offences in the CzechRepublic has remained stable in recent years. The number of offenders prosecutedand sentenced for drug offences increased slightly in 2006. The proportion of offenders prosecuted for the offence of possessionof drugs for personal use (Section 187a of the Penal Code) in all drug offences has remained between 8 and 10% since 2001. Most drug offences (60%) relate to pervitin, 30% to cannabis; the proportion of pervitin has been increasing and the proportion of cannabis and other drugs has been declining in recent years. The number of cocaine- and ecstasy-related criminal offences continues to be low. The highest number of persons prosecuted for drug-related criminal offences in proportion to the number of inhabitants was reported in the Karlovy Vary, Ústí nad Labem, and Prague regions; in absolute numbers in Ústí nad Labem and Prague. According to a police estimate, drug users committed approximately 14,000 (11%) of all cleared-up and 74,000 (22%) of all detected criminal offences; approximately 9,000 of the cleared-up offences and 66,000 of the detected ones were represented by thefts.
Most of the marijuanaconsumed in recent years has probably been domestically produced; growing cannabis(mostly a small quantity of plants) in artificial conditions has become widespread. Pervitin is made exclusively in the Czech Republic; imported ephedrine or pseudoephedrine obtained from medical preparations is used as a precursor. Pervitin is also exported abroad, especially to Germany. Ecstasy and cocaine(originating from South America) are especially imported from the Netherlands, while heroinis imported from Afghanistan via the so-called Balkan route. The number and volume of seizures of the main types of drugs in 2006 were approximately the same as in the previous years; seizures of marijuana and pervitinwere the most common, and the number of cocaine and ecstasyseizures has remained low in the long term. Drug prices and purity did not change markedly in 2006.